Okay, we’re assuming, number one, that you have done a good job diagnosing ADD or ADHD, and that ADHD is the primary diagnosis, far out-shadowing any comorbid problems that may also be present. And number two, we are assuming that you, the patient, and the parents (if the patient is under age) have all agreed that now is the time for a medication trial.

Six short years ago, an influential study came out in Archives of General Psychiatry that was widely interpreted as showing that therapy adds little of value to the treatment of ADHD (Arch Gen Psychiatry 1999; 56:1073-1086).

On February 9, 2005, Health Canada (HC) announced that it was suspending sales of Adderall XR in Canada because of concerns that it might lead to sudden death and stroke. The FDA, however, has begged to differ.

Amphetamine was first synthesized in Germany in 1887. It became popular as a recreational drug in the US in the 1930s. While cocaine was declared illegal in 1914, amphetamines were widely available, and were often used by college students and truck drivers.

So, you want to be a bias-buster? Gird yourself, because it’s not an easy task. In order to establish the presence of commercial bias, you have to demonstrate two things: first, that the activity is funded by industry; and second, that the content of the program is unreasonably slanted toward the sponsor’s product.

It probably comes as little surprise to most readers that manufacturer-sponsored research is more likely to yield an outcome favorable to the sponsored product than similar non-sponsored research. What may be surprising is that there is actually a good-sized body of published research (non-sponsored, of course!) on this very topic.

There is trouble for the pharmaceutical industry in CME City. The ACCME (Accreditation Council for Continuing Medical Education), which sets national standards for accredited CME activities, has tightened up its requirements for commercial support, which is giving drug companies, private medical education firms, and assorted hired guns a collective case of indigestion.

Many readers have wondered why I decided to publish The Carlat Report. Well, back in the day, I was a member of the speaker’s bureau of four pharmaceutical companies. I would typically travel to the offices of primary care physicians nearby and talk up the sponsor’s drug.

1992 was a very big year in the history of the relationship between the FDA and the pharmaceutical industry. That year, Congress passed the Prescription Drug User Fee Act (PDUFA), allowing the FDA to charge pharmaceutical companies hundreds of thousands of dollars per drug for the drug approval process.

Here’s a scenario for you. You have five medications to choose from. They are all FDA approved for the same indications. Any head-to-head study among them has shown equivalent efficacy. Three of them are associated with significant weight gain, hypercholesteremia, and diabetes risk. Two of them are not. Your job is to take a stand on what you would recommend as "first-line" medication for the disorder in question.